Passive Euthanasia in India: Between Constitutional Morality and Lived Reality

The question of death is one such legal question which test the parameters of the morality premised upon constitutional democracy in a more insightful way. At the nexus of the discourse around euthanasia, especially passive euthanasia, there lies the interplay of law, ethics, medicine, and human dignity. The inherent ethical and moral deadlock around this debate is: whether the law should allow an individual to abstain from all forms of life-sustaining treatments and opt for a dignified death instead of suffering perpetually at the support of medical interventions?

Passive euthanasia mainly incorporates the removal of life-sustaining treatment or withholding of medical interventions such as medicated nutrition, hydration, or ventilators to let the individual die naturally. This is distinct from its counterpart, active euthanasia, where the life of the patient is taken deliberately through pharmaceutical interventions, such as by administering a lethal injection. The legal and ethical rhetoric in India has evolved surrounding the distinction between “killing” and “letting die”, marking its way for vigilant adoption of passive euthanasia. The last 30 years remain a testament to this fact, where the constitutional jurisprudence has transitioned in a remarkable way on this issue. The Supreme Court has interpreted the “right to life” in a more inclusive way in recent years by including other associated facets such as dignity, autonomy, and the right to refuse treatment. In spite of such expansive interventions, there remains a disparity between constitutional morality and lived reality. This article delineates the legal and ethical journal of passive euthanasia in India while examining its constitutional jurisprudence, along with addressing the comparative framework. 

Conceptual Foundations of Passive Euthanasia 

The functionality of passive euthanasia relies upon the ‘omission’ that is the discontinuation of the life-sustaining support or medical interventions like the feeding tubes, ventilators, or artificial hydration in those medical cases where the recovery of the patient is implausible. Such patients suffer from terminal illness or remain in a permanent vegetative state (PVS). On the other hand, active euthanasia requires a deliberate act to end the life of the patient. The legal repercussions of both these types are too divergent. As in India, active euthanasia is considered illegal and is attributed as culpable homicide under the criminal law. Whereas the legal journey of passive euthanasia is complex because of judicial interpretations that have been conditionally legalised over the years due to the struggles which such patients have undergone. 

Three intertwined ethical rationales are woven to conceptualise passive euthanasia. One, autonomy, is considered an indispensable attribute of the individual’s right to take autonomous decisions regarding their own bodies. Second, dignity, which emanates from the fundamental right to live in a dignified manner, where a patient’s dignity is being compromised while living with vulnerable and permanent vegetative conditions. Last, medical futility, that provides justifications regarding the futility of the medical treatment and interventions in light of the patient’s condition. 

In light of these ethical justifications, the constitutional question which has been reflected by the Supreme Court over the years is whether Article 21, guaranteeing the right to life and personal liberty, also enables the right to die with dignity. Interestingly, the apex court took a responsible approach by not explicitly recognising “right to die” but recognised that no person should die in an undignified way due to prolongation in a vegetative state. 

Judicial Evolution of Passive Euthanasia in India

The early judicial position regarding the right to die is indisputable. In Gian Kaur v. State of Punjab (1996), the Supreme Court held that “the right to life does not include the right to die”. However, the court recognised that in some cases where terminal illness is in question, the right to life may include the right to die in a dignified manner. The minuscule obiter dicta laid the foundation for the constitutional jurisprudence of passive euthanasia. 

The milestone in this regard came through the landmark judgment of Aruna Shanbaug v. Union of India (2011). The facts of the case reveal that Aruna Shaunbaug was a nurse who became the victim of a heinous sexual assault, which put her in a vegetative state for 42 years, following which a plea for euthanasia was filed on her behalf. Supreme Court, through its key finding, recognised passive euthanasia in principle. However, while drawing upon the distinction between active and passive euthanasia, it didn’t credit active euthanasia. It further laid down the guidelines under which an approval for the withdrawal of life support is required from the High Court by following the stipulated procedure. The concept of decision-making by the relatives or a “next friend” was introduced in the key findings, subject to judicial oversight. Even though the court did not allow euthanasia to Shanbaug, it laid the foundation stone for future cases of passive euthanasia. 

In Common Cause v. Union of India (2018), the constitution bench shaped the jurisprudence to its constitutional maturity through three significant contributions. The court held that in the cases of terminal illness or irreversible medical conditions involving patients in a permanent vegetative state, the right to life under Article 21 also includes the right to die with dignity. The court provided the legal recognition to the advance directives (living wills), in which individuals are free to document their preferences in advance regarding the medical treatment and their consent mechanism, ensuring that their autonomy and dignity are not compromised if such an individual reaches a medical condition where they are incapable of expressing consent. The court also prioritised the autonomy of the patients against judicial paternalism, where it has been held that individuals have complete autonomy regarding their medical decisions, which includes the refusal of treatment. Subsequently, in 2023, refinements in the procedural requirements were made by the Supreme Court to make the living wills more accessible and freer from bureaucratic hurdles. 

Recently, in Harish Rana v. Union of India (2026), the court allowed passive euthanasia, which was the first practical implementation of the theory to practice. In this case, the court directed the removal of clinically assisted nutrition and hydration as prescribed, while emphasising dignity and human procedure. This case marked a significant turn in the jurisprudence of passive euthanasia. 

Constitutional and Ethical Dimensions

Though it took nearly three decades, the constitutional and ethical dimensions regarding passive euthanasia in India reflect a proper balancing of competing values. The sanctity of life, autonomy, and dignity have been prioritised, where individuals have the right to make decisions regarding their bodies and health-related issues. Also, the responsibility of the state in the capacity of parens patriae has been invoked to protect the vulnerable individuals from abuse or coercion. The Indian approach to centre passive euthanasia around the withdrawal of medical treatment to avoid undignified prolongation of life is considered a nuanced uptake to reconcile constitutional morality with lived realities. 

Comparative Perspectives
Legal responses to euthanasia are being shaped by cultural, ethical, and institutional notions globally when studied comparatively. Such legal responses are categorised in three models, i.e., liberal, restrictive, and hybrid, reflecting the way in which countries adopt these models. 

In countries like the Netherlands, Belgium, and Canada, the liberal model is being adopted. The Netherlands is the first country to legalise euthanasia and physician-assisted suicide since 2002. Patients suffering unbearably without any signs of improvement are required to submit a voluntary and well-considered request for euthanasia, including its active counterpart. In Belgium, euthanasia is allowed for non-terminal conditions of the patient, wherein the law is extended to minors under strict safeguards, which is a very expansive approach regarding euthanasia globally. In Canada, the progressive stance is visible through the recognition of Medical Assistance in Dying (MAID), which legalised euthanasia as well as assisted suicide by integrating it into their healthcare systems, requiring strict eligibility criteria and medical oversight. In these jurisdictions, a liberal regime of euthanasia is noted by prioritising autonomy and perceiving euthanasia as a legitimate medical option. 

In the United Kingdom, Japan, and other Asian countries, a restrictive model is being adopted. In the UK, euthanasia as well as assisted suicide are illegal, and withdrawal of treatment is permitted but with stringent measures. In Airedale NHS Trust v. Bland (1993), the House of Lords permitted the withdrawal of life support for a patient who was in a permanent vegetative state, akin to passive euthanasia in India. Similarly, in Japan and other Asian countries, active euthanasia is illegal, whereas passive euthanasia is allowed but with regulatory ambiguity under stringent conditions. In these countries, a restrictive model is noticed because active euthanasia is completely illegal, whereas there remains a lot of procedural irregularity for passive euthanasia. 
Hybrid and moderate approaches are noticed particularly in the United States and India. The US model is decentralised, where passive euthanasia is widely accepted. In some states like Oregon and Washington, physician-assisted suicide is also legalised. In Cruzan v. Director, Missouri Department of Health (1990), the right to refuse medical treatment was recognised, which is identical to the recognition of autonomy and dignity in India. This hybrid approach is also noticed in India, wherein a middle path has been taken by prohibiting active euthanasia and permitting passive euthanasia under procedural safeguards and guidelines given by the apex court, emphasising dignity, autonomy, and procedural compliance. The hybrid model commits both the constitutional commitments and the lived realities. 

Challenges in the Indian Framework 

Even though the commitments of the judiciary have reformed the jurisprudence of euthanasia, there still persist a few challenges which are to be addressed properly. India’s euthanasia framework has been primarily developed by the Supreme Court. There are legal uncertainties and inconsistencies in the absence of comprehensive legislation, in spite of having the Supreme Court guidelines. After the 2023 reforms in the guidelines, the procedure has been simplified, but because it still involves medical boards, documentation, and institutional approvals, there remain procedural complexities which eventually delay decision-making. Socio-cultural attributions of the Indian society have always laid emphasis on the sanctity of life and familial decision-making, which often complicates the decision-making for end-of-life choices, leading to various conflicts related to autonomy and dignity of an individual. The major challenge is the risk of misuse, wherein concerns are raised regarding the practices of coercion and economic pressure on the patient, affecting their consent and putting the patient on the verge of vulnerability and exploitation. 

Way Forward

In order to bridge the gap between constitutional morality and lived realities, certain measures are suggested. It is necessary to codify legislation on passive euthanasia by incorporating the comprehensive Supreme Court jurisprudence regarding procedural safeguards and guidelines. Dedicated legislation on the issue would ensure clarity, uniformity, and accessibility for the patients requiring interventions. Promotion of living wills is required for empowering individuals to make informed decisions about their end-of-life choices. Developing medical ethics and practices around passive euthanasia is required for ethical compliance for the healthcare professionals and the supporting staff involved. Transparency and accountability can be increased by expanding the independent review mechanism. 

Conclusion

The evolution of passive euthanasia from a restrictive model to a more moderate model reflects decades of constitutional and judicial interventions for creating a nuanced understanding of dignity, autonomy, and human existence. The Gian Kaur case provided cautious observations, the Shanbaug case enabled debate towards recognition, and the Common Cause case culminated in a progressive intervention, until the very recent Harish Rana case, where the theory finally converted into practice, paving the way for future scenarios. However, the journey is far from complete as there is a long way to go by codifying a specific legislation coupled with procedural and ethical safeguards, which could only let passive euthanasia realise its complete functionality. In the final analysis, the question of euthanasia is not merely about “right to die”, but instead it is about the dignity, autonomy, and individual choices on which the meaning of life relies. The time has come for taking decisive steps in the direction where constitutional morality could turn into a lived reality in a more efficient manner.